Some hematomas cause significant pain because they are trapped in small
spaces that do not allow room for the bleeding to expand. For example, a
subungual hematoma underneath the fingernail may be intensely painful because
there is no room between the nail bed and the tightly adherent nail bed. A few
drops of blood that can accumulate from a crush injury like hitting a finger
with a hammer may cause exquisite pain. The treatment may include burning a
small hole through the nail itself to allow the blood to drain.
Other hematomas cause problems because they press on the underlying tissue
and that pressure may hamper the normal blood supply and cause long lasting
damage and scarring.
- Hematomas of the ear may occur if an injury causes bleeding to the outside
helix or cartilage structure of the ear. Blood can get trapped between the thin
layer of skin and the cartilage itself and since the ear cartilage gets its
blood supply directly from the overlying skin, a hematoma can decrease blood
flow causing parts of the cartilage to shrivel and die. This is a common
complication seen in wrestlers and boxers.
- Nose injuries may cause a similar issue with the cartilage that makes up
the septum of the nose. A septal hematoma may form associated with a
and if not recognized and removed, the cartilage can break down and cause a
perforation of the septum.
- Internal bleeding into the abdomen may be life-threatening depending upon the
cause and the situation. Hemorrhage and hematoma may be due to a variety of
injuries or illnesses but regardless of how the blood gets into the abdomen, the
clinical finding is that of peritonitis, irritation of the lining of the
- Hematomas may occur in solid organs like the liver, spleen and kidney
or they may occur within the walls of the small intestine or colon. Hematomas
may also form within the lining of the abdomen called the peritoneum or behind
the peritoneum in the retroperitoneal space (retro=behind) where the kidneys are
- Hematomas and bleeding due to orthopedic injuries are common because of how
blood rich bones are. Bone marrow is where much of the body's blood production
occurs and a fracture may cause significant blood loss.
Compartment syndrome is
an uncommon complication of bleeding and hematoma due to injury. The muscles of
the forearm and shin are contained in compartments that tightly adhere to bone.
If a hematoma due to fracture or contusion grows and expands, the pressure
within the compartment can increase to the point where blood cannot flow to
muscle causing it to die. This is a true orthopedic emergency and requires an
operation to filet open the compartments to allow room for the swelling and
decrease the pressure. Symptoms of compartment syndrome include intense pain
made worse with movement of the fingers or toes, numbness and tingling of the
extremity, and decreased pulses in the hand or foot.
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